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Is the Problem with the Ventricle Rate?
The irregular ventricular rate can be used in the medical examination as a major indicator allowing diagnosing a patient with atrial fibrillation (January et al., 2014). A way to detect the ventricular rate is to administer ECG. Mr. Martinezs ECG showed such irregularity, and this is why atrial fibrillation was considered on the differential diagnosis stage of the case examination. Faulty electrical signals originating in ventricles indicate atrial fibrillation with the rapid ventricular response (Anderson et al., 2013).
This conditions three major symptoms are pounding heart, fatigue, and shortness of breath. Mr. Martinez qualifies for the described condition, which is why it can be said that the ventricular rate is the problem in the presented case. The patients ventricular rate can be controlled through the use of pharmacologic therapies; treatment will normally include beta-blockers and calcium channel blockers ( AFib with the rapid ventricular response, 2015); these will help avoid hemodynamic instability.
Is the Pulse Ox Reliable in Atrial Fib?
The method of pulse oximetry cannot be fully trusted in the cases of patients diagnosed with atrial fibrillation (or in the cases in which atrial fibrillation is suspected) (Tamie, 2013). A major complication is that fibrillation makes the signal needed for the proper functioning of a pulse oximeter too weak and hard to detect. Also, fibrillation means an increased rate, and this interferes with oximetry.
A way to address this issue is to dynamically adjust oximeters to patients under clinical conditions. Ward et al. (2012) suggest using the method of overnight pulse oximetry to rule out sleep-disordered breathing in patients with atrial fibrillation. A major concern is that atrial fibrillation prevents pulse oximetry in a large portion of patients. In the case of Mr. Martinez, additional or alternative methods can be considered for examination.
References
AFib with rapid ventricular response. (2015). Web.
Anderson, J. L., Halperin, J. L., Albert, N. M., Bozkurt, B., Brindis, R. G., Curtis, L. H., & Ohman, E. M. (2013). Management of patients with atrial fibrillation (Compilation of 2006 ACCF/AHA/ESC and 2011 ACCF/AHA/HRS Recommendations). Journal of the American College of Cardiology, 61(18), 1935-1944. Web.
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cleveland, J. C., Cigarroa, J. E., & Yancy, C. W. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. Web.
Tamie, J. P. (2013). Pulse-ox does not assess A-Fib correctly. Web.
Ward, N. R., Cowie, M. R., Rosen, S. D., Roldao, V., De Villa, M., McDonagh, T. A., & Morrell, M. J. (2012). Utility of overnight pulse oximetry and heart rate variability analysis to screen for sleep-disordered breathing in chronic heart failure. Thorax, 67(11), 1000-1005. Web.
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